Analysis on correlation between orthodontic pain score and occlusal function at 24 h after first time treatment in patients with fixed-orthodontics / 重庆医学

Objective To investigate the correlation between the orthodontic pain score and occlusal function at 24 h after the first time treatment in the patients with fixed orthodontics.Methods Seventy-eight voluntary subjects were selected and treated with MBT straight wire correcting appliance.The VAS scores of spontaneous odontalgia and biting odontalgia (SO-VAS and BOVAS),masticatory efficiency (ME),masticatory times (MT),maximal occlusal force(MF)and occlusion rate before wearing the fixed appliance(T0),at 24 h after wearing(T1) were measured.The changes of above indicators were observed and the correlation among indicators was investigated:Results (1) BO-VAS and SO-VAS were increased after 24 h of orthodontic treatment,while BO VAS was (59.49 ± 19.06) mm,which was significantly higher than SO-VAS[(23.21± 20.80) mm].After 24 h of fixed orthodontic treatment,the patients had occlusal dysfunction,which manifested by ME,MT,MF and SO decrease compared with T0 (P＜0.05).(2) BO-VAS was negatively correlated with ME,MT and MF (P＜0.05).There was no correlation between SO-VAS and occlusal dysfunction.Conclusion There is no obvious magnitude correspondence relation between the occlusal dysfunction grade and the pain grade on the first day after fixed orthodontic treatment,the VAS grading is not yet fully representative of the occlusal dysfunction level,but the credibility of BO-V.AS score is higher than that of SO-VAS score in assessing the degree of occlusal dysfunction.

Analysis on correlation between orthodontic pain score and occlusal function at 24 h after first time treatment in patients with fixed-orthodontics / 重庆医学

Objective To investigate the correlation between the orthodontic pain score and occlusal function at 24 h after the first time treatment in the patients with fixed orthodontics.Methods Seventy-eight voluntary subjects were selected and treated with MBT straight wire correcting appliance.The VAS scores of spontaneous odontalgia and biting odontalgia (SO-VAS and BOVAS),masticatory efficiency (ME),masticatory times (MT),maximal occlusal force(MF)and occlusion rate before wearing the fixed appliance(T0),at 24 h after wearing(T1) were measured.The changes of above indicators were observed and the correlation among indicators was investigated:Results (1) BO-VAS and SO-VAS were increased after 24 h of orthodontic treatment,while BO VAS was (59.49 ± 19.06) mm,which was significantly higher than SO-VAS[(23.21± 20.80) mm].After 24 h of fixed orthodontic treatment,the patients had occlusal dysfunction,which manifested by ME,MT,MF and SO decrease compared with T0 (P＜0.05).(2) BO-VAS was negatively correlated with ME,MT and MF (P＜0.05).There was no correlation between SO-VAS and occlusal dysfunction.Conclusion There is no obvious magnitude correspondence relation between the occlusal dysfunction grade and the pain grade on the first day after fixed orthodontic treatment,the VAS grading is not yet fully representative of the occlusal dysfunction level,but the credibility of BO-V.AS score is higher than that of SO-VAS score in assessing the degree of occlusal dysfunction.

Pain measurement in oral and maxillofacial surgery

Regardless of whether it is acute or chronic, the assessment of pain should be simple and practical. Since the intensity of pain is thought to be one of the primary factors that determine its effect on a human's overall function and sense, there are many scales to assess pain. The aim of the current article was to review pain intensity scales that are commonly used in dental and oral and maxillofacial surgery (OMFS). Previous studies demonstrated that multidimensional scales, such as the McGill Pain Questionnaire, Short form of the McGill Pain Questionnaire, and Wisconsin Brief Pain Questionnaire were suitable for assessing chronic pain, while unidimensional scales, like the Visual Analogue Scales (VAS), Verbal descriptor scale, Verbal rating scale, Numerical rating Scale, Faces Pain Scale, Wong-Baker Faces Pain Rating Scale (WBS), and Full Cup Test, were used to evaluate acute pain. The WBS is widely used to assess pain in children and elderly because other scales are often difficult to understand, which could consequently lead to an overestimation of the pain intensity. In dental or OMFS research, the use of the VAS is more common because it is more reliable, valid, sensitive, and appropriate. However, some researchers use NRS to evaluate OMFS pain in adults because this scale is easier to use than VAS and yields relatively similar pain scores. This review only assessed pain scales used for post-operative OMFS or dental pain.

Preliminary Clinical Results of Topaz Microdebridement Procedure in Lateral Epicondylitis Patients / 대한스포츠의학회지

The purpose of this study is to clinically evaluate and report the effectiveness of radiofrequency microdebrider (Topaz, ArthroCare) treatment in lateral epicondylitis patients. From March to July 2003, 15 patients of 17 elbows were prospectively followed. Candidate for the treatment were lateral epicondylitis patients who had symptom more than 6 month and failed to respond to conservative treatment, including medication (non-steroidal anti-inflammatory drugs), external gel or patch, and steroid injections. All patient who scored greater than grade 3 (fair) on the Self-administered Roles and Maudsley Pain (SRMP) score were selected for the procedure. All procedure was done using local anesthesia and ArthroCare microdebrider by a single surgeon. Postoperative assessments were done on postoperative period 12 month of two previous subjective scores and a simple functional assessment asking better, same, or worst function after the procedure. Mean age of the patients was 45 years old. Mean symptom duration before the procedure was 22.6 months. After the procedure, the mean Pain Visual Analogue Scale improved from 7.3 (range, 5–9; standard deviation [SD], 1.2) preoperatively to 3.7 (range, 0–7; SD, 2.1) postoperatively (p< 0.001). After the procedure, five elbows showed no rating improvement, in seven elbows 1 level improvement, in four elbows 2 level improvement, and in one elbow 3 level improvement. Overall, 71% (12/17) showed improvement after the procedure according to the SRMP score rating. Although 29% (5/17) of the elbow showed no improvement on SRMP score, among them five elbows were still rated decrease in Pain Visual Analogue Scale.

A Comparative Efficacy of Propacetamol and Ketorolac in Postoperative Patient Controlled Analgesia

BACKGROUND: Ketorolac has been used as a postoperative analgesia in combination with opioids. However, the use of ketorolac may produce serious side effects in vulnerable patients. Propacetamol is known to induce fewer side effects than ketorolac because it mainly affects the central nervous system. We compared the analgesic effects and patient satisfaction levels of each drug when combined with fentanyl patient-controlled analgesia (PCA). METHODS: The patients were divided into two groups, each with n = 46. The patients in each group were given 60 mg of ketorolac or 2 g of propacetamol (mixed with fentanyl) for 10 minutes. The patients were then given 180 mg of ketorolac or 8 g of propacetamol (mixed with fentanyl and ramosetron) through PCA. We assessed the visual analogue pain scale (VAS) at the time point immediately before administration (baseline) and at 15, 30, and 60 minutes, and 24 hours after administration. Also, the side effects of each regimen and each patient's degree of satisfaction were assessed. RESULTS: There was a significant decline in the VAS score in both groups (P < 0.05). However, there were no significant differences in the VAS scores between the groups at each time point. Satisfaction scores between the groups showed no significant difference. CONCLUSIONS: The efficacy of propacetamol is comparable to that of ketorolac in postoperative PCA with fentanyl.

Acupuntura na fibromialgia: um estudo randomizado-controlado abordando a resposta imediata da dor / Acupuncture in fibromyalgia: a randomized, controlled study addressing the immediate pain response

Objetivo Avaliar a eficácia da acupuntura no tratamento da fibromialgia, considerando-se como desfecho primário a resposta imediata da escala visual analógica (VAS) para avaliação da dor. Material e métodos Estudo randomizado, controlado e duplo-cego incluindo 36 pacientes portadores de fibromialgia (ACR 1990) selecionados no ambulatório de Reumatologia da Santa Casa de Misericórdia de Ponta Grossa, PR. Vinte e um pacientes foram submetidos a uma sessão de acupuntura, nos moldes da Medicina Tradicional Chinesa, e 15 pacientes foram submetidos a um procedimento placebo (acupuntura sham). Para avaliação da dor, os indivíduos preencheram uma Escala Visual Analógica (VAS) antes e imediatamente após o procedimento proposto. As médias na variação da VAS foram comparadas entre os grupos. Resultados A variação entre o valor da EVA final e da EVA inicial foi de –4,36±3,23 (P=0,0001) no grupo de tratamento e de –1,70±1,55 no grupo de controle (P=0,06). A diferença na amplitude de variação da EVA (EVA inicial – final) entre os grupos favoreceu o procedimento verdadeiro (P=0,005). O tamanho de efeito (effect size – ES) para o grupo de tratamento foi de d=1,7, o que é considerado um efeito grande. Embora com uma amostra reduzida, seu poder estatístico para esses resultados foi bastante relevante (94,8%). Conclusão A acupuntura mostrou ser eficaz na redução imediata da dor em pacientes portadores de fibromialgia, com um tamanho de efeito (effect size) bastante significativo. .

Objective To evaluate the efficacy of acupuncture in the treatment of fibromyalgia, considering the immediate response of the visual analogue pain scale (VAS) as its primary outcome. Methods Randomized, controlled, double-blind study including 36 patients with fibromyalgia (ACR 1990) selected from the outpatient rheumatology clinic, Santa Casa de Misericórdia, Ponta Grossa, PR. Twenty-one patients underwent an acupuncture session, under the principles of the traditional Chinese medicine, and 15 patients underwent a placebo procedure (sham acupuncture). For pain assessment, the subjects completed a Visual Analogue Scale (VAS) before and immediately after the proposed procedure. The mean change in VAS was compared among groups. Results The variation between the final and initial VAS values was -4.36±3.23 (P=0.0001) in the treatment group and -1.70±1.55 in the control group (P=0.06). The difference in terms of amplitude of variation of VAS (initial – final VAS) among groups favored the actual procedure (P=0.005). The effect size (ES) for the treatment group was d=1.7, which is considered a large effect. Although small, the statistical power of the sample for these results was very relevant (94.8%). Conclusion Acupuncture has proven effective in the immediate pain reduction in patients with fibromyalgia, with a quite significant effect size. .

Do Severity Score and Skin Temperature Asymmetry Correlate with the Subjective Pain Score in the Patients with Complex Regional Pain Syndrome? / 대한통증학회지

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.

Do Severity Score and Skin Temperature Asymmetry Correlate with the Subjective Pain Score in the Patients with Complex Regional Pain Syndrome?

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.

Control del dolrr postquirúrgico en pacientes de un hospital de tercer nivel / Conrol of postopperative pain in patients in a tertiary hospital / Conrole da dor ppós-cirúrgica em pacientes de um hospital de terceiro níeel

Introducción: el manejo del dolor debe ser adaptado y optimizado de acuerdo con las condiciones de cada hospital, tipo de cirugía y paciente. Objetivos: ealuar la percepción del dolor de los pacientes intervenidos en el postoperatorio del Hospital Universitario San Jorge de Pereira. Materiales y métodos: Se realizó un estudio de corte, prospectivo en pacientes mayores de 18 años entre 2 de septiembre y 28 de octubre de 2011. La valoración de intensidad del dolor postoperatorio se realizó mediante Escala Visual Analógica a las 24 horas del postquirúrgico. Se consideraron variables sociodemográficas, clínicas (tipo de cirugía, anestesia, riesgo) y farmacológicas (medicamentos empleados, dosis, intervalos dosificación). El análisis se hizo con SPSS 20.0 para Windows. Resultados: Se evaluaron 153 pacientes en postoperatorio, 80 (52,3%) mujeres y 73 (47,7%) hombres, con edad promedio de 47,6 ± 20,2 años. El 38,8% de los pacientes no tenía controlado el dolor. Las variables de cirugía ortopédica, el empleo de anestesia general por vía intravenosa, y el incumplimiento de los intervalos recomendados de dosificación de los analgésicos, se asociaron de manera estadísticamente significativa con la falta de control. Discusión: El control del dolor fue inadecuado haciendo evidente la necesidad de replantear su manejo ajustado a guías de práctica clínica, formalizando el uso de medicamentos, en dosis e intervalos adecuados que garanticen una analgesia efectiva.

Introduction: Pain management should be adapted and optimized according to the conditions of each hospital, type of surgery and patient. Objectives: To evaluate the perception of pain in postoperative patients at Hospital Universitario San Jorge of Pereira. Materials and methods: A descriptive observational study in patients older than 18 years, between September 2nd to October 28, 2011. The assessment of postoperative pain intensity was performed by visual analogue scale 24 hours after surgery. We considered socio-demographic, clinical (type of surgery, anesthesia, risk) and pharmacological variables (drugs used, dosage, dosage intervals). The analysis was done with SPSS 20.0 for Windows. Results: We evaluated 153 patients in the postoperative period, 80 (52.3%) women and 73 (47.7%) males, mean age 47.6 ± 20.2 years. 38.8% of patients did not obtain pain control. The variables of orthopedic surgery, the use of intravenous general anesthesia, and suboptimal dosage was statistically significantly associated with lack of control. Conclusions: Pain control was inadequate thus showing the need to redefine its management by following clinical practice guidelines, through the use of analgesics in doses and appropriate intervals.

Introdução: o manejo da dor deve ser adaptado e otimizado de acordo com as condições de cada hospital, tipo de cirurgia e paciente. Objetivos: avaliar a percepção da dor dos pacientes intervindos no pós operatório do Hospital Universitário San Jorge de Pereira. Materiais e métodos: Realizou-se um estudo de corte, prospectivo em pacientes maiores de 18 anos entre 2 de setembro e 28 de outubro de 2011. A valoração de intensidade da dor pós-operatória se realizou mediante Escala Visual Analógica às 24 horas do pós-cirúrgico. Consideraram-se variáveis sociodemográficas, clínicas (tipo de cirurgia, anestesia, risco) e farmacológicas (medicamentos empregados, doses, intervalos, dosagem). A análise se fez com SPSS 20.0 para Windows. Resultados: Se avaliaram 153 pacientes em pós-operatório, 80 (52,3%) mulheres e 73 (47,7%) homens, com idade média de 47,6 ± 20,2 anos. O 38,8% dos pacientes não tinha controlada a dor. As variáveis de cirurgia ortopédica, o emprego de anestesia geral por via intravenosa, e o descumprimento dos intervalos recomendados de dosagem dos analgésicos, se associaram de maneira estatisticamente significativa com a falta de controle. Discussão: O controle da dor foi inadequado fazendo evidente a necessidade de repensar o seu manejo ajustado a guias de prática clínica, formalizando o uso de medicamentos, em doses e intervalos adequados que garantam uma analgesia efetiva.

Evaluación de la calidad de la atención del paciente con dolor en fase terminal: estudio descriptivo transversal / Quality of care for patients with end-stage pain: descriptive, cross-sectional study

Nuestro trabajo tiene como objetivo general el evaluar la calidad de la atención a los pacientes con dolor en etapa terminal. Específicamente, se busca determinar la intensidad del dolor aplicando La Escala Análoga Visual del Dolor; evaluar el grado de incapacidad funcional aplicando la Escala de Prolo modificada; correlacionar la intensidad dolorosa con la potencia analgésica de los fármacos utilizados, teniendo en cuenta la Escalera Analgésica de la Organización Mundial de la Salud; así como la capacidad para participar en la toma de decisiones a la hora de realizar un proceder y el real conocimiento de su enfermedad. Para ello seleccionamos 50 pacientes de un universo de 100. Los pacientes incluidos venían remitidos de las consultas de las diferentes especialidades médicas y de oncología con diagnostico de dolor por cáncer. Se les aplico una entrevista individual realizada por el especialista de la Clínica del Dolor Crónico. Se cuantificó la intensidad dolorosa, se determinó el grado de incapacidad funcional, tratamientos farmacológicos previos, información médica sobre la enfermedad, posibilidades terapéuticas, complicaciones y el uso de morfínicos. Como resultado de nuestro estudio pudimos apreciar que el 56 por ciento de los pacientes padecían dolor moderado e intenso, que el grado de incapacidad funcional era malo, que desde el punto de vista farmacológico habían sido inadecuadamente tratados y que la mayoría desconocían la causa de su dolor.

Our work has as general objective to evaluate the quality from the attention to the patients with pain in terminal stage and specifically to determine the intensity of the pain applying the similar visual scale of the pain, to evaluate the grade of functional inability applying the scale of modified PROLO, to correlate the painful intensity with the analgesic power of the used medications keeping in mind the Analgesic Stairway of OMS, as well as the capacity to participate in the taking of decisions when carrying out a to proceed and the real knowledge of its illness. For we select it 50 patients, of an universe of 100 patients, the included patients came remitted of the consultations of the medical different Specialties and of Oncology with I Diagnose of pain for cancer, he/she is applied an individual interview carried out by the specialist of the Clinic of the Chronic pain. You quantify the painful intensity, you determines the grade of functional inability, pharmacological previous treatments, Information prescribes on the illness, therapeutic possibilities, complications and the morphine use. As a result of our study we could appreciate that 56 percent of the patients suffered moderate and intense pain that the grade of functional inability was bad that you/they had been treated improperly from the pharmacological point of view, and that most ignored the cause of its pain.

The Early Experience of Hand Assisted Laparoscopic Surgery in Nephroureterectomy / 대한비뇨기과학회지

PURPOSE: Recently, the growing interest in minimally invasive surgery and the development of instruments and accompanying techniques have allowed laparoscopic surgery to be performed in a wide range of urological fields. Herein, the procedures and results of 6 cases of hand assisted laparoscopic surgery (HALS) nephroureterectomy are reported. MATERIALS AND METHODS: The records of 6 and 5 patients, who had undergone either a laparoscopic HALS nephroureterectomy, with bladder cuff excision, or an open nephroureterectomy, with bladder cuff excision, were reviewed. RESULTS: The mean operation times were 194 (150-210) and 280 (250-310) minutes in HALS nephroureterectomy and open nephroureterectomy, respectively. The average pain scales recorded with HALS and classical open surgery were 1.5 (max. 2) and 7 (max. 8), respectively, on the second post operative day. CONCLUSIONS: HALS allows the operator to be notified with on-the-spot information and to have a feeling of complete control over the procedure, which helps to complete the operation in a shorter time, with the assistance of a tactile impression. Therefore, HALS can be concluded to be a better approach, which is a more acceptable procedure for the novice laparoscopic surgeon.

The Experience of Modified Flexible Cystoscopy in Male Patients / 대한비뇨기과학회지

PURPOSE: A flexible cystoscopic examination is well tolerated compared to a rigid cystoscopic examination in male patients. A modified flexible cystoscope was designed, and its discomfort and efficacy evaluated compared with a rigid cystoscope. MATERIALS AND METHODS: 104 patients underwent a cystoscopic examination, of which 37 underwent both rigid and modified flexible cystoscopic examinations, and 37 and 30 only a modified flexible cystoscopic or rigid cystoscopic examination, respectively. An observer visual analog pain scale was applied after the procedure, and the rating of discomfort recorded. RESULTS: In the group that underwent both examination types, the mean pain scores were 1.8 and 6.4 after the modified flexible cystoscopic and rigid cystoscopic examinations, respectively (p<0.001). In the individual cystoscopic groups, the mean pain scores were 2.6 and 6.0 after the modified flexible and rigid cystoscopic examinations, respectively (p<0.001). The vision of modified flexible and rigid cystoscopes was the same. CONCLUSIONS: A modified flexible cystoscopic examination was well tolerated by patients, and can be routinely used in place of the rigid counterpart for follow-up of bladder tumors and as a diagnostic procedure for a gross hematuria. Some modifications, such as a more ample working channel and an integral video camera, will be needed.

A Comparison Study on the Effects of the Variable Combination of Drugs Through Thoracic Epidural Catheter with General Anesthesia / 대한마취과학회지

Comparing with the simple general anesthesia, the combined thoracic epidural and general anesthesia generally provide with more improved regional endocardial perfusion, reduced myocardial oxygen consumption, eventually reduced postoperative morbidity and mortality. Patients undergoing thoracotomy have severe pain and related cardio-respiratory impairment postoperatively, so large amount of the analgesics are usually administered systemically. Recently, the method using epidural injection of the local anesthetics and/or analgesics is prefered during and after the operation because of its excellent analgesic action and advantage of lowering the need for anesthetics and systemic analgesics but has remaining problems such as eardiopulmonary and CNS depression and reduced motor function and so on. So, in an attempt to reduce the untoward effects of epidural injection, we planned to evaluate the validity of the mixing local anesthetic, bupivacaine, and narcotic analgesic, fentanyl, in a given concentration and infusion rate and randomized 70 patients undergoing thoracotomy into 4 groups. Group A(n=20): Intermittent intramuscular injection of nalbuphine hydrochloride in a dose of 0.2 mg/kg Group B(n=15): Continuous epidural infusion of fentanyl citrate, 2-5 ml/hr of 5 mcg/ml solution Group C(n=15): Continuous epidural infusion of bupivacaine hydrochloride, 2-5 ml/hr of 0.15% solution Group D(n=20): Continuous epidural infusion of mixtures of fentanyl and bupivacaine, 2-5 ml/hr of same concentrations We observed the visual analogue pain scale perioperatively and measured the hemodynamic parameters such as cardiac output, cardiac index, systemic vascular resistance, stroke volume, mean arterial pressure and heart rate. The results were as follows: I) The postoperative analgesic outcome was best in group D as compared with other groups. 2) The cardiac output decreased postoperatively in group A, B and C while group D showed an increase but there was no statistical significance. 3) The cardiac index decreased significantly in group B and sbowed a trend of decreasing in group C, increasing in group D, and no change in group A. 4) The stroke volume decreased postoperatively in group A and B but the significance was only in group A. 5) The systemic vascular resistance showed significant postoperative increase in group B. 6) The mean arterial pressure decreased in group D and increased in other groups. 7) The heart rate increased during and immediate after the operation in group B.